Abstract
Sedative agents─such as benzodiazepines─and analgesics are generally used during endoscopic procedures. However, despite expectations, in some cases benzodiazepines are ineffective. In those cases, haloperidol (HLP) and propofol are used, but it has not yet been clearly established in which cases benzodiazepines will be ineffective. In order to identify predictors for this scenario, we analyzed cases of patients who underwent endoscopic submucosal dissection (ESD) for treatment of early gastric or esophageal cancer using sedative agents. ESD was performed in 169 patients with solitary lesions at our institute between November 2011 and June 2012. The patients were divided into a standard group (using midazolam (MZ) and pethidine hydrochloride (PH) ; 152 patients (90%) ) and an HLP group (using MZ, PH and additional HLP ; 17 patients (10%) ) . We retrospectively analyzed factors in cases that required additional use of HLP.
In the HLP group, patients were younger, consisted of more men, with a larger body surface area, had a greater history of drinking and smoking within the previous year, and were more likely to have large and/or esophageal lesions compared to the standard group. Furthermore, the HLP group needed significantly higher doses of MZ and PH during the preoperative endoscopic examination, and a higher PH dose and longer procedure time during endoscopic resection compared to the standard group. Significant factors determined by univariate analysis were examined using multivariate analysis. Three significant factors were thus identified : “age < 60 years”, “diameter of the lesion ≧ 30 mm” and “MZ dose (during preoperative endoscopic examination) ≧ 0.06 mg/kg”. These factors are useful to predict the requirement for additional HLP during ESD procedures.
